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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> ��3•� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM PG(J G�7,) - �3 <br /> SITE ADDRESS - LEN��O � ppRCEL TAX I.D.# P�RMIT# <br /> E���i� qPd.o3 QO�Oh 7 0600 �/S�� [` U'�'�' -}3 <br /> LEGAL LOTNO. � BLOCK TRACT s,S 00�'� OI <br /> DESC. <br /> OWNER ADDRESS cirrm���y PHONE <br /> NI��A'�J'� yb(��vA- gU.O�/i� 0 �10 .�mf�✓� w �✓c��6�/A �1L.�b53-30d�b <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � :��•. . , . � � �����^ � ' ' ' .`f"�S3s3 �3,u� <br /> CONTRACTOR N���� a,,�N;e ADDRESS CITY!'LIP PHONE <br /> ' , �8(D S� Fnic" w• �Jc��i;f w� • . <br /> CONTR�EICENSE�i� ;� ..�".ii � . ` ' . . � � � �8��. 11�f-�rSJ3 - 3�6 <br /> . 1 <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> 5u,k,�E FAw,��7' <br /> � �;�)Y N 1'� _Electric �Gas_Other <br /> � <br /> WORK DEuCRIPTION J 4;7��� � 3 7V� � <br /> �� y� ��3 ?s� <br /> �u,i I o N t�,.� +-c.o wd E ym o �� k a� 9� o <br /> '733 [.-�a.t ti � �,��d S <br /> S3 I�� �m <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUkE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 5 Toilet /j�!. A/C-air handling unils <br /> �_ Balhtub �,'� Forcedairsystems <br /> ,,:'� Lavatory(wash basin) / '��;� �� � Gas piping <br /> Shower �� I Water healer <br /> �_ Kilchen sink&disposal _L Gas fireplace <br /> L_ Dishwaslier Gas range <br /> � Clolhes washer �_ Clolhes dryer <br /> �;(;_ Waterheater � Exhaust(an ��� �� � <br /> __ Sink(service/barlmop/etc.) ' <br /> BackOow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Ofher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ord�naces goveming this type of work will be complied wilh whether specified herein or nol The granting of a pertnil does nol presume <br /> lo givo aulhorily lo violale or cancel the provision of any olher slate or local law regulaling construclion or lha performance of <br /> construclion.That I am aulhorized by the owner of lhis property lo periorm the work for which application is made and I comply with the <br /> Stale C lors Law 18.27 RCW and 296.200 WAC. <br /> Ni�O� �u�1r.+i� � a ss <br /> Signa of OwnedContractor/Aulhorized Agent Date 1 <br /> , � v <br /> s'�.> �� <3�� <br />